• Stefano Maria Priola, Chinthaka Heyn, and Leodante da Costa.
• Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. Electronic address: stefanopriola@gmail.com.
• World Neurosurg. 2019 Jun 1; 126: 605-610.

BackgroundRadiculomedullary arteries aneurysms are rare, with only few cases so far reported.Case DescriptionWe report the case of a 54-year-old woman with sudden onset of upper thoracic back pain. Magnetic resonance imaging/magnetic resonance angiography of the spine showed a cervico-thoraco-lumbar hematoma, with no evidence of underlying vascular malformations. Using Phantom retractors, a unilateral laminectomy was performed at the level of T3, in proximity of the thickest part of the epidural hematoma. No epidural blood was detected. The dura was opened, and subdural and subarachnoid blood was found. After its removal, a fusiform aneurysm of the right radiculomedullary artery was found. The parental vessel was temporarily clipped and the aneurysm removed after ligation of both proximal and distal vessels. No postoperative complications occurred.ConclusionsRupture of radiculomedullary artery aneurysm always should be considered as differential diagnosis in patients with sudden onset of isolated back pain, headache, and spinal epidural/subdural bleeding. Among different possible treatments, surgery represents a valid option. The use of microsurgical techniques is crucial to achieve a good clinical outcome. A minimally invasive approach can be used to minimize muscle disruption, with minimal blood loss, and faster recovery.Copyright © 2019 Elsevier Inc. All rights reserved.

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